Date post: | 24-Dec-2015 |
Category: |
Documents |
Upload: | bruno-dennis |
View: | 212 times |
Download: | 0 times |
Taking Charge:Understanding Tobacco Control’s
Impact on CommunitiesChristine Cheng, Partner Relations Director,
Smoking Cessation Leadership Center
Shelina D. Foderingham, Director Practice Improvement,The National Council
Kansas Health Foundation, Fellows Program Friday, November 14, 2014 – Wichita, KS
© 2012 BHWP2
Today’s Topics
• Overview: National Landscape• SCLC Partnerships: State and Local Community• Tobacco Control: Leading Preventable Cause of
Death• Health Systems Changes• Barriers and Myths• Group Exercise
National Council for Behavioral Health
82250 CBHOs
750,000 staff
Advocacy & Education
SAMHSA-HRSA CIHS, 2014
National Landscape
22.1 million Americans>12 years old
Substance Use Disorder
25-40 million AmericansIn Recovery
National Landscape
SAMHSA-HRSA CIHS, 2014
National Landscape
Cancer and Behavioral Health
More than 50% of people with terminal cancer have at least one psychiatric disorder.
Individuals with a mental illness may develop cancer at a 2.6 times higher due to late stage diagnosis because of inadequate screenings.
Individuals with a mental illness have a higher rate of fatality due to cancer.
SAMHSA-HRSA CIHS, 2014
What is the National Council doing?
• Learning Collaborative and Communities – SUD,
FQHC• SAMHSA-HRSA Center for Integrated Health
Solutions• NY State Geriatric Technical Assistance Center • Ohio Training & Technical Assistance Center
• CDC Capacity Building and National Behavioral
Health Network for Tobacco & Cancer Control
10
Practice Improvement & Workforce Development
Jointly funded by CDC’s Office on Smoking & Health & Division of Cancer Prevention & Control
Provides resources and tools to help organizations reduce tobacco use and cancer among people with mental illness and addictions
1 of 8 CDC National Networks to eliminate cancer and tobacco disparities in priority populations
Free Access to…Toolkits, training opportunities, virtual communities and other resources
Webinars & Presentations
State Strategy Sessions
#BHtheChange
Visit www.BHtheChange.org and Join Today!
© 2012 BHWP12
© 2012 BHWP13
Smoking Cessation Leadership Center• Began in 2003 as a Robert Wood Johnson
Foundation National Program Office • Subsequent grants from Legacy Foundation to
address behavioral health, ARRA grant, CDC/CTG grants, SAMHSA for pioneers and state summits
• Aims to increase smoking cessation rates and increase the number of health professionals who help smokers quit.
© 2012 BHWP14
How We Work
• Identify champions • Create partnerships • Help create action plans • Do not reinvent the wheel• Low cost, no cost resources• Promote message through health journals,
publications and social media
© 2012 BHWP15
SCLC and Behavioral Health
• Convened leaders in BH for a summit in 2007• Meeting at SAMSHA with the then administrator
Terry Cline in 2008, which lead to …• SAMHSA 100 pioneers initiative in 2009• SAMHSA leadership academy for wellness and
smoking cessation with 8 states from 2010-13• SAMHSA policy academy held in June 2014
© 2012 BHWP16
SAMHSAIn-Service Training Poster
July 7, 2008
© 2012 BHWP17
• Grantees from all 3 SAMHSA centers:o CMHS, CSAT, CSAP
• Wide range of interventionistso Consumer groupso Health care providerso Community centerso Treatment centerso Youth o Rehabilitation centers
• 2nd phase of initiative with 25 Pioneers
100 Pioneers for Smoking Cessation
© 2012 BHWP18
SAMHSA Pioneers Map
Blue = Phase I PioneersYellow = Phase II Pioneers
Represent 38 states
© 2012 BHWP19
Performance Partnership Model• Used in all 8 SAMHSA leadership academy states • Partnership organized around a specific,
measurable result, asking 4 questions:1. Where are we now? (baseline) % intervene
with patient who smoke or current prevalence2. Where do we want to be? (target) increase to
% in xx years or decrease prevalence by xx%3. How will we get there? (multiple strategies) 4. How will we know we are getting there?
(evaluation/measures)
© 2012 BHWP20
Leadership Academies for Wellness and Smoking Cessation
• 2010-2013 Leadership Academies for Wellness and Smoking Cessationo Purpose: To launch statewide partnerships among
behavioral health providers, consumers, public health groups, and other stakeholders to create and implement an action plan to reduce smoking prevalence among behavioral health consumers and staff.
o Eight states selected to participate in 1-2 day planning summits
© 2012 BHWP21
8 State Leadership Academies
8
© 2012 BHWP22
Leadership Academy Participants• State mental health department• State substance abuse department• State tobacco control department/state Medicaid department• Consumer organizations• Hospitals• Federal agency representatives from SAMHSA, HRSA, CDC, VA • Academic medical centers• State branches of national advocacy groups such as NAMI or MHA• Patient advocacy groups• Community advocacy groups• Youth organizations• Insurance companies• SCLC Leadership and staff• Results-based facilitator
© 2012 BHWP23
2012 Progress Report:Common Strategy Groups
• Consumers and Community: 6 out of 7 states• Provider Education: 6 out of 7 states• Data Development: 5 out of 7 states• State Level Policy: 5 out of 7 states• Behavioral Health Facilities: 4 out of 7 states• Quitline: 4 out of 7 states
© 2012 BHWP24
2013: Impact: Awareness of Tobacco Intervention among BH Providers
71% or 5 out of 7 states strongly agree
© 2012 BHWP25
State Leadership Academies Strongly Interested in Partnering with Others
100% or all 7 states strongly interested in partnering with other states
© 2012 BHWP26
Tobacco: Leading PreventableCause of Death
1. How many annual deaths are caused by smoking?
2. What was the national prevalence in 1964 when the first Surgeon General’s report on smoking and health was released?
© 2012 BHWP27
Tobacco’s Deadly Toll
• 480,000 deaths in the U.S. each year• 4.8 million deaths world wide each year• 10 million deaths estimated by year 2030• 50,000 deaths in the U.S. due to second-hand smoke
exposure• 8.6 million disabled from tobacco in the U.S. alone• 46.6 million smokers in U.S. (78% daily smokers)
© 2012 BHWP28
Behavioral Causes of Annual Deaths in the United States
20
85
4329 17
365
0
50
100
150
200
250
300
350
400
450
Nu
mb
er
of d
ea
ths
(th
ou
san
ds)
Mokdad et al, JAMA 2004; 291:1238-1245. Mokdad et al; JAMA. 2005; 293:293
Sexual Alcohol Motor Guns Drug Obesity/ Smoking Behavior Vehicle Induced Inactivity
Also suffer from mental illness and/or substance abuse
*
*
435
© 2012 BHWP29
“All smokers with psychiatric disorders, including substance use disorders, should be offered tobacco dependence treatment, and clinicians must overcome their reluctance to treat this population” (Fiore et al., 2008, p. 154).
29
2008 Tobacco Dependence Clinical Practice Guideline
© 2012 BHWP30
Health Consequences of Smoking
U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General, 2014.
Cancers:– Acute myeloid leukemia – Bladder and kidney– Cervical– Colon, liver, pancreas– Esophageal– Gastric– Laryngeal– Lung– Oral cavity and pharyngeal– Prostate (↓survival)
Pulmonary diseases:– Acute (e.g., pneumonia)– Chronic (e.g., COPD)– Tuberculosis
Cardiovascular diseases– Abdominal aortic aneurysm– Coronary heart disease– Cerebrovascular disease– Peripheral arterial disease– Type 2 diabetes mellitus
Reproductive effects– Reduced fertility in women– Poor pregnancy outcomes (ectopic
pregnancy, congenital anomalies, low birth weight, preterm delivery)
– Infant mortality; childhood obesityOther effects: cataract; osteoporosis;
Crohn’s; periodontitis,; poor surgical outcomes; Alzheimer's; rheumatoid arthritis; less sleep
© 2012 BHWP31
Causal Associations with Second-hand Smoke• Developmental
– Low birth weight– Sudden infant death
syndrome (SIDS)– Pre-term delivery-- Childhood depression
• Respiratory– Asthma induction and
exacerbation– Eye and nasal irritation– Bronchitis, pneumonia, otitis
media, bruxism in children– Decreased hearing in teens
• Carcinogenic– Lung cancer– Nasal sinus cancer– Breast cancer (younger,
premenopausal women)
• Cardiovascular– Heart disease mortality– Acute and chronic coronary
heart disease morbidity– Altered vascular properties
USDHHS. (2006). The Health Consequences of Involuntary Exposure to Tobacco Smoke: Report of the Surgeon General.
There is no safe level of second-hand smoke.
© 2012 BHWP32
Medications that SmokingDecreases Blood Levels
Brand Name Generic NameElavil* AmitriptylineAnafranil* ClomipramineAventyl/Pamelor* NortiptylineTofranil* ImipramineLuvox* FluvoxamineThorazine* ChlorpromazineProlixin* FluphenazineHaldol* HaloperidolClorizaril* ClozapineZyprexa* OlanzapineTylenol AcetominophenInderal PropanololSlo-bid, Slo-Phyllin, TheophyllineTheo-24, Theo-Dur,Theobid, Theovent
Caffeine*Psychoactive medications
© 2012 BHWP33
Youth Smoking
• 1,000 American adolescents become regular tobacco users every day
• Early teen smokers with low nicotine exposure already show brain activation
patterns of heavy adult smokers • Youth smoking is associated with mental and addiction disorders later in life
© 2012 BHWP34
Never Too Late to Quit*
Age of quitting smoking Years of life saved25-34 1035-44 945-54 855-64 4
* Jha, NEJM Jan 24, 2013
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7
Systems Changes: We Know What Works
• Raising tobacco taxes and price• Tobacco-free indoor air laws and workplace
tobacco bans • State prevention and cessation initiatives (e.g. quit
line)• Combination of NRT and counseling• Restriction of tobacco sales to minors• Anti-tobacco counter-marketing efforts
C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7
www.TheNationalCouncil.org
Going Tobacco-Free
36
© 2012 BHWP37
Barriers and Myths Poll
1. Should you do concurrent tobacco cessation & addiction treatment and/or MH treatment?
© 2012 BHWP38
Smoking & Behavioral Health:A Health Disparity Issue
• Elevated prevalence of use • Targeted marketing by the tobacco industry • Serious health consequences • Significant costs & social isolation • Enabling environments • Lower access to treatment • Inadequate research base
© 2012 BHWP39
Major Target Market
• 44% to 46% of cigarettes consumed in the U.S. by smokers with psychiatric or addictive disorders (Lasser, 2000; Grant, 2002)
• 175 billion cigarettes and $39 billion in annual tobacco sales (USDA, 2004)
© 2012 BHWP40
Smoking Prevalence by MH Diagnosis2007 NHIS data• Schizophrenia 59.1%• Bipolar disorder 46.4%• ADD/ADHD 37.2%
Current smoking: • 1 MH 31.9%• 2 MH 41.8%• 3+ MH 61.4%
Grant et al., 2004, Lasser et al., 2000• Major depression 45-50%• Bipolar disorder 50-70%• Schizophrenia 70-90%
© 2012 BHWP41
Usually if a person has not started smoking by age 20, it is unlikely they will ever smoke. However, a significant number of adults start smoking while in treatment/recovery, suggesting the treatment climate is conducive to smoking.*
Unintended Consequences of Addictions Treatment
* Friend & Pagano, 2004
© 2012 BHWP42
Myths
• Individuals with mental illness don’t want to quit
• Individuals with mental illness can’t quito False – can and do quit at a rate slightly lower
than the general population
• Treating tobacco use concurrent is detrimental to recovery and/or mental illnesso False – increase sobriety by 25%*
*Prochaska, et. al., 2006
© 2012 BHWP43
Just as Ready to Quit Smoking as theGeneral Population
© 2012 BHWP44
Smokers with Bipolar Disorder:Online Survey (N=685)
• Few reported a psychiatrist (27%), therapist (18%), or case manager (6%) ever advised them to quit smoking (Prochaska, Reyes, Schroeder, et al. (2011). Bipolar Disorders)
Several reported discouragement to quit from mental health providers
© 2012 BHWP45
Need for Smoking Intervention
• Tobacco treatment needs to be a higher priority for behavioral health.
• While focusing on addictions and mental health, clinicians sometimes miss this more deadly condition.
• Addressing tobacco use can improve health, ease pain, and save lives.
Leadership Activity
• If we’re moving towards integrated care, within your sphere of influence, how will you incorporate tobacco control & prevention efforts targeting people with SMI?• How will you address the specific needs of
priority populations (i.e., racial/ethnic minorities, low SES, rural/frontier, and LGBT)?
Leadership Activity
• How are you incorporating tobacco cessation activities as part of your KHF implementation plan?
Leadership Activity
• Would you push for tobacco cessation & what is your role as a leader within your organization?• Who’s responsible for ensuring that tobacco control
efforts meet the needs of SMI populations? In treatment settings? In public health? In communities? And How do we implement this?
• Would you push for tobacco cessation efforts for SMI populations…
• Name 1 thing you learned from this exercise.
• Name 1 thing that you will do when you go home to improve tobacco control efforts.
Report Out from Leadership Activity
© 2012 BHWP50
Questions and Answers
© 2012 BHWP51
Contact US!
Shelina Foderingham [email protected], ext. 272
Christine [email protected] or toll free, 877-509-3786
© 2012 BHWP52
Indoor Smoking Room
Kinston Psychiatric Hospital, NJ